Contract : 5753 Vendor : Quest Diagnostics Description ...

Contract : 5753 Vendor : Quest Diagnostics

Pricing for frequently ordered tests is provided below. For all other tests not listed below, Contractor will provide a 65% discount off of their fee schedule. Contractors Fee Schedule is provided in Exhibit C. For any tests that appear in both the Frequently Ordered Tests List

and the Fee Schedule, the pricing provided in the Frequently Ordered Tests List will prevail.

Frequently Ordered Tests

Description Cholesterol Comprehensive Metabolic Panel w/eGFR Chlamydia/GC DNA Amplified Drug Screen 7 Panel Drug Screen 9 Panel Drug Screen 10 Panel Hepatitis B Surface Antibody Quantitative Hepatitis C Antibody Hepatic Function Panel HIV 1/2 EIA Antibody with Reflexes HPV DNA (High Risk) Herpes Simplex Type 2 lgG, HerpeSelect Lipid Panel Pap, ThinPrep, No RESCRN Pap, ThinPrep, RESCRN Triglycerides TSH, 3rd Generation Urine Culture Varicella-Zoster lgG Surgical pathology, gross and microscpic exam Level IV profile 47 Nicotine Urine 6224 Hepatitis CaB 1590 QuantiFERON-TB 8 Panel Drug Screen Pregnancy, Urine PTT Culture, Wound Valproic Acid Vit D, 25 Hydroxy Gram Stain Culture, Aerobic Protime + INR Prothrombin Time EBV-VCA IGG AB T3 Free EBV AB IGM

Code 6165 944 17618 800 822 821 7292 1590 104 3200 110814 100051 1383 10090 1090 6440 7580 2400 123112 AC03

47 6224 1590 4399 819 4723 4023 2275 7590 17306 2025 2300 4021 111126 140465 1430 151599

Unite Price Time $3.75 24hr $6.43 24hr

$49.10 24hr $8.24 3-5 days $9.46 3-5 days

$10.11 3-5 days $9.75 24hr

$11.33 24hr $4.93 24hr $8.68 24hr

$33.48 24hr $24.44 24hr $12.10 24hr $20.00 5 days $20.00 5 days

$3.75 24hr $11.75 24hr

$8.43 24hr $18.00 6 days $64.43 24-48 hr $26.54 24hr $25.50 5 days $11.33 24hr $43.35 5 days

$8.87 3-5 days $8.60 24hr $4.50 24hr $21.00 varies $12.00 24hr $58.00 9 days $5.00 24hr $16.00 varies $5.00 24hr $5.00 4 days $18.25 4 days $5.62 24hr $18.25 4 days

Contract : 5753 Vendor : Quest Diagnostics

Pricing for frequently ordered tests is provided below. For all other tests not listed below, Contractor will provide a 65% discount off of their fee schedule. Contractors Fee Schedule is provided in Exhibit C. For any tests that appear in both the Frequently Ordered Tests List

and the Fee Schedule, the pricing provided in the Frequently Ordered Tests List will prevail.

Frequently Ordered Tests

Description

Code

Tissue Transglutam IGA

1549

RA Diagnostic Panel

17669

Group A Strep Rapid Scn

2031

Strep Scn Group A

2032

Group A Strep No Rfx

2034

CMV AB Profile

3100

CMV IGG AB

3105

HIV- 1 WB W/RFX HIV-2

3214

Heterophile, Mono Scn

4317

Sed Rate Westergren

4542

HIV-1 AB West Blot

5233

Lithium

6315

HCG, Total, Quant

7275

Vitamin B12

7610

CMV AB IGM

3110

CMV AB IGM

12486

Western Blot HIV-1

3215

Percentage Discount Allowed off fee schedule for tests not listed

Unite Price Time

$68.00 4 days $102.82 3 days

$7.50 TBD $7.50 TBD $7.50 TBD $45.50 24hr $13.00 24hr $42.39 TBD $18.25 24hr $4.21 24hr $42.39 TBD $9.83 24hr $24.62 24hr $49.00 24hr $32.50 24hr $32.50 4 days $42.39 TBD

65%

Stat Testing Charge per specimen

$16.95

Stat Courier Charge

$7.74

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION ELECTROLYTES PANEL PROFILE 68 (SPRUE PANEL) PROFILE 88 PROFILE 101 ANEMIA PROFILE 103 ELECTROLYTES AMA HEPATIC FUNCTION PNL OBSTETRIC PANEL HEPATITIS B SURVEILLANCE NEEDLESTICK/EXPO PROF 145 ALLERGEN PROFILE 184 RAST FOODS COMPREHENSIVE RAST HOUSEHOLD INHALANTS REGIONAL PLANTS PROFILE PROFILE 193 RAST MYELOMA PROFILE 222 AUTOIMMUNE PROFILE 224 PROFILE 271 PRENATAL ALLERGEN PROFILE 279 PROFILE 283 IMMUNE COMPET C3, C4, COMPLEMENT CH50 ALLERGEN GRASSES PROFILE ALLERGEN WEEDS PROFILE ALLERGEN INDOOR INHALANTS ALLERGEN TREES PROFILE ALLERGEN MOLDS PROFILE ALLERGEN PEDIATRIC FOOD ALLERGEN MEATS PROFILE ALLERGEN GRAINS PROFILE ALLERGEN PROFILE 311 T-HELPER PANEL IRON,TIBC AND FERRITIN HEPATITIS PANEL, ACUTE ALLERGEN PROF 392 (RAST) GLUCOSE TOLERANCE 2HR GLUCOSE TOLERANCE 1HR GLUCOSE TOLERANCE 2 HOUR GLUCOSE TOLERANCE 3HR GLUCOSE FAST AND GEST ALLERGEN PROF 427 (RAST) GTT,GESTATIONAL,4 SPEC GLUCOSE TOLERANCE 5 HOUR CSF PROFILE MYELOMA PROFILE 635 PROFILE 688 ZINC ALUMINUM SERUM DIARRHEA PROFILE 786 PROFILE 800 7 PANEL TOX PROFILE 819 8 PANEL TOX PROFILE 821 10 PANEL TOX PROFILE 822 9 PANEL TOX PROFILE 866 7 PANEL TOX THYROGLOBULIN PANEL RENAL FUNCTION PANEL COMP METAB WITH EGFR THYROID PANEL (T3U,T4,T7) BASIC METABOLIC PAP 1 SLIDE (SCRN) HUMORAL IMMUNITY STATUS PAP INTERP BY DR ERA/PRA IMMUNOPEROXIDASE ERA/PRA IMMUNO NON-BREAST

CODE 42 68 88 101 103 104 125 133 145 184 187 188 189 193 222 224 271 279 283 284 300 301 302 303 304 305 306 307 311 346 359 365 392 406 410 412 418 425 427 428 441 480 635 688 784 786 800 819 821 822 866 900 916 944 975 982

1000 1048 1081 1088 1089

Quest Fee Schedule

PRICE

DESCRIPTION

$3.52 $101.85

$12.78 $24.96

HIV1 RNA QNT RLTM PCR CSF INTERFERON BETA 1A INTERFERON BETA 1B AB BUPRENORPHINE W/O CONF,UR

$4.73 $4.05 $50.16 $53.24 $44.17

ANTIMICROBIAL,RIFABUTIN MAGNESIUM, 24 HOUR URINE OPIATES CONF, UR MDMA/MDA, QUANT, UR HEPATOCELLULAR CARCINOMA

$189.00 $119.00

$56.00 $98.00 $182.00

C-KIT MUTATIONS W/REFLEX ARBOVIRUS AB PNL, CSF INFLUENZA A H1/H3 RT PCR RESPIRATORY PNL W/H1N1 BASE PROF W/CONF, UR

$89.57 $154.00

$61.18 $189.00 $198.35

$65.49 $35.00 $28.00 $42.00

BASE PROF W/O CONF, UR PROCALCITONIN FUNGITELL(1-3)-B-D-GLUCAN SRA ASSAY LMWH SRA ASSAY FONDAPARINUX PLATELET AB SCR INDIRECT QUANT HIV-1 RT PCR (NIH) GTT GESTATIONAL 4 SPEC IGF-1 ELECTROCHEM

$35.00 $35.00 $35.00 $28.00 $35.00

OPIATES EXPANDED,QUANT,UR FRAGILE X DNA ANLYS FETUS CAMPYLOBACTER SPECIES AG BUPRENORPHINE SCR W/CONF XSENSE FRAGILE X W/RFLX

$91.00 $172.83

$29.44 $98.31 $252.00

BUPRENORPHINE QUANT URINE HEMOGLOBIN A1C WITH EAG OSTEOCALCIN, N-MID XSENSE(R)FRAGILE X W/RFLX LINEZOLID, HPLC

$7.60 $7.32 $15.79 $15.79 $8.96

THROMBOPOIETIN (TPO) GENOMIC ALTER PRENATAL EML4-ALK GENE FUSION PCR HISTAMINE, PLASMA S PNEUMONIAE IGG AB,MAID

$259.00 $15.79 $26.29 $17.85

$132.34

C DIFFICILE TOXON B CATECHOLAMINES SUPINE CATECHOLAMINES FRAC CMV IGG/IGM CSF ENCEPHALITIS AB PANEL

$9.49 $70.70 $121.07

$8.24 $8.87

FENTANYL SCREEN UR W/RFLX EBV PANEL, CSF HIV-1 GENOTYPE TROPISM HIV-1 VIRTUAL PHENOTYPE PNH W/FLAER

$10.11 $9.46 $8.24

$66.33 $4.57

CORTISOL FREE RESPONSE X3 CHRONIC URTICARIA PANEL JC POLYOMA VIRUS DNA, CSF JC POLYOMA DNA, CSF JC POLYOMA VIRUS DNA, UR

$5.27 $11.52

$4.22 $12.00 $316.40

$0.84 $89.18 $96.01

JC POLYOMA VIRUS DNA, UR TSH RECEPTOR ANTIBODY PROF 1 W/CONF, UR PROF 2 W/CONF, UR PROF 3 W/CONF, UR BASE PROF W/CONF, UR LUNG CANCER MUTATION PNL STEPWISE PART 1

CODE 16186 16201 16202 16207 16208 16213 16215 16216 16222 16237 16240 16251 16255 16259 16260 16265 16283 16284 16285 16288 16290 16292 16293 16298 16300 16302 16310 16313 16314 16320 16322 16326 16328 16336 16340 16344 16354 16374 16377 16381 16382 16385 16405 16407 16420 16430 16431 16433 16434 16440 16441 16442 16446 16447 16453 16454 16455 16456 16457 16461 16463

PRICE $101.85 $162.40 $162.40 $60.00 $64.05 $24.17 $100.00 $100.00 $143.50 $350.00 $241.15 $104.30 $417.20 $159.39 $159.39 $85.75 $96.25 $91.00 $91.00 $80.50 $103.25 $14.98 $54.25 $100.00 $133.00 $33.95 $21.00 $105.00 $35.00 $16.45 $50.75 $327.25 $64.05 $43.75 $556.50 $192.50 $47.95 $108.15 $42.00 $52.85 $52.85 $59.15 $281.40 $12.25 $104.65

$1,690.00 $591.50 $196.88 $131.25 $128.10 $104.30 $122.15 $122.15 $104.30 $80.50 $259.00 $159.39 $192.59 $159.39 $459.90 $68.25

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

PAP,THIN LYR,RESCRN(DIAG) PAP,THIN LYR,RESCRN(SCRN) FACTOR VII AG. AMINOLEVULINIC ACID,RND POLIOVIRUS POST VACCINE 11-DEOXYCORTISOL DRAW AND PROCESS REFERRED DRAW AND SHIP SPECIMEN ACETYLCHOLINE RECEPT.BIND FLUVOXAMINE (LUVOX) ACTH, PLASMA CORTISOL, PRE ACTH CORTISOL, POST ACTH ACTH STIMULATION,PRE/POST ALUMINUM ANDROSTENEDIONE,LC/MS/MS STINGING INSECT,IGE W/O T ANTI-DNASE GLOMERULAR BASEMENT MEMB. G6PD QUANTITATIVE CHROMIUM, RANDOM URINE OXALATE ARSENIC, QUANTITATIVE BCR/ABL GENE REARRANGEMEN MESTINON PORPHYRINS,FRACTION, PL ARSENIC,QUANTITATIVE,UR EPIDERMAL AB W/REFLEX VITAMIN B-12 BINDING BETA-2-MICROGLOBULIN ANGIOTENSIN II BETA 2 MICROGLOBULIN B. HERMSII IGG/IGM AB BRUCELLA ANTIBODY STRONGYLOIDES IGG ABS C1 INHIBITOR, PROTEIN KETAMINE COMPLEMENT C2 ADRENAL AB W/RFL TITER COMPLEMENT C5 IGG/ALBUMIN RATIO FUNGAL SUSCEPT MIC PANEL CA 125 ALPHA 2 ANTIPLASMIN CA 19-9 CA 27.29 CALCITONIN NEOPTERIN CARNITINE VON WILLEBRANDS FACTOR AG B. HENSELAE IgG,IgM REFLX CATECHOLAMINES, FRACT. ALLERGEN WHITE ASH CATECHOLAMINES, 24 HR UR CHLAMYDOPHILA PSITTACI AB ALLERGEN ITALIAN CYPRESS BACTERIAL ANTIGEN PANEL CATECHOLAMINES, FRACT METHYLMALONIC/HOMOCYSTEIN COPPER, URINE PLASMINOGEN

CODE

1090 1091 1112 1147 1156 1205 1206 1216 1229 1231 1232 1233 1236 1237 1241 1253 1255 1256 1259 1262 1263 1267 1271 1272 1275 1276 1277 1279 1286 1289 1291 1292 1293 1295 1299 1301 1303 1307 1308 1310 1311 1312 1313 1315 1319 1320 1322 1323 1328 1332 1334 1340 1341 1343 1346 1347 1349 1350 1356 1364 1366

Quest Fee Schedule

PRICE

DESCRIPTION

$22.66 $69.50 $180.00

STEPWISE PART 2 GENOMIC ALTERATIONS PROF 4 W/CONF, UR

$25.20 $28.18 $57.75 $28.50 $65.50

PROF 4 W/CONF, UR HISTOPLASMA AB PANEL, CSF PROF 4 W/O CONF, UR HYPERSENSITIVITY PNEUMO HE4,OVARIAN CANCER MONITR

$57.75 $101.00

$38.50 $21.42 $21.42

INFLM BWL DIS DIFF PANEL METHYLMALONIC ACID URINE KRAS MUTATION ANALYSIS PHOSPHOLIPIDS, SERUM UGT1A1 GENOTYPING

$42.84 $45.85 $58.45 $35.00 $22.75

FISH TOP2A GENE AMP BIOTINIDASE DEFICIENCY LEPTOSPIRA AB W/RFLX RETICULIN IGG SCRN W/RFLX 1911A>G MUT ANALYSIS

$49.70 $23.80 $32.55 $127.00 $45.85 $151.20 $272.00 $43.75 $45.85

JAK2 EXONS 12-13 MUTATION BIOTINIDASE ACTIVITY JAK2 V617F,QL,LEUMETA W/R JAK2 V617F MUTATION BK VIRUS DNA,QL,RT,PCR UR CPK W/CKMB IF INDICATED VITAMIN D 1,25-DIHYDROXY THYROGLOBULIN FN ASPIRATE PTH, INTACT, FNA

$17.50 $27.65 $32.55 $31.15 $31.50

FUNGAL ID,PHENOTYPE & SEQ FUNGAL SEQUENCING ITS REG BK VIRUS DNA,QNT,RT,PCR U FISH,LYMPHOID MYB del6q23 TREPONEMA PALLIDUM DNA

$66.50 $49.00 $53.20 $33.25 $101.00

C. BURNETII DNA,QL,RLTM IODINE, SERUM & PLASMA IODINE 24-HOUR URINE ETHYL GLUCURONIDE SULFATE CYP2C19 GENOTYPING

$31.50 $24.50 $33.60 $33.25 $188.30

HUMAN METAPNEUMOVIRUS HEXA MUTATION ANALYSIS PHOSPHATIDY IgG,IgA,IgM NUCLEAR MATRIX PROTEINS LYME DISEASE AB, TOTAL

$32.48 $35.35 $34.30 $40.60 $54.25

CELIAC DISEASE PANEL 1 RETT SYN REARRANGE DELDUP FISH, DUPLICATION 22Q11.2 PHOSPHATIDYLCHOLINE IGG PHOSPHATICYLCHOLINE IGM

$45.85 $58.45 $51.45 $52.15 $52.85

PHOSPHATIDYLCHOLINE IGA PHOSPHATIDYLETHANOLA IgG PHOSPHATIDYLETHANOLAM IgM PHOSPHATIDYLETHANOLAM IgA HSV AB IGM W/RFL TITER

$7.00 $49.35 $36.75

$7.00 $54.43 $64.75 $98.00 $26.25 $49.00

PHOSPHATIDYLINOSITOL IgM PHOSPHATIDYLINOSITOL IgA EPSTEIN-BARR VIRUS ISH IGG,IGA INDRCT IMMUNFLOR ORGANIC ACID URINE QUANT HEP B VIRUS DNA, W/RFLX IMMUNOGLOBULIN CSF PROF INSCAPE ER/PR/HER2 QNT HIV-1 CORECEPTOR TROPISM

CODE

16465 16478 16483 16484 16485 16486 16490 16500 16503 16508 16510 16513 16521 16523 16526 16529 16530 16533 16536 16537 16538 16539 16553 16555 16558 16559 16560 16578 16579 16581 16593 16595 16596 16599 16602 16604 16605 16607 16612 16619 16645 16646 16652 16662 16672 16677 16678 16679 16680 16681 16682 16684 16685 16686 16688 16690 16693 16694 16705 16707 16710

PRICE

$169.75 $840.00 $242.40 $242.40

$58.45 $242.40 $161.70

$89.60 $175.00

$49.70 $203.00

$27.65 $113.75 $157.50 $262.15

$33.60 $22.75 $104.65 $175.00 $35.70 $175.00 $175.00 $107.80

$8.16 $79.45 $31.50 $52.50 $105.00 $105.00 $122.15 $207.55 $104.30 $104.30 $28.35 $35.00 $40.95 $542.50 $38.15 $441.00 $108.50 $43.75 $17.50 $124.60 $323.75 $128.80 $36.17 $36.17 $36.17 $36.17 $36.17 $36.17 $26.25 $36.17 $36.17 $57.75 $64.75 $132.65 $113.75 $42.00 $210.00 $437.50

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

CREATINE, URINE CYSTINE QUANTITATIVE, UR CHLAMYDIA DNA PROBE GONORRHEA DNA PROBE (GC) DHEA,LC/MS/MS CHLAMYDIA DNA SCRN W/RFLX GROUP B STREP DNA PRB CUL LIPID PANEL MULTIPLE SCLEROSIS PANEL ALPHA SUBUNIT 3HR GTT/INSULIN TOLERANCE PORPHYRINS, 24HR QUANT. PTH INTACT/IONIZ CALCIUM REVERSE T3 POLIO VIRUS ANTIBODY COXSACKIE A VIRUS PANEL HIV 1&2 ANTIBODIES T3, FREE MAG AUTOANTIBODY NEURONAL NUCLEAR (RI) YO (PURKINJE CELL) AB NEURONAL NUCLEAR (HU) HU AND YO AUTOANTIBODY GIARDIA ANTIBODIES (IFA) HEP C SUPPLEMENTAL (RIBA) HALOPERIDOL (HALDOL) HAEMOPHILUS INFLUENZA B ANTI GLIADIN ANTIBODIES HEAVY METALS, URINE HISTAMINE, URINE LATEX RIA PANEL IGG SUBCLASSES INSULIN INSULIN, SPECIMEN 2 HANTAVIRUS (SIN NOMBRE) A1-ANTITRYP.QNT/PHENO GROUP B STREP DNA PRB CUL NEURONTIN (GABAPENTIN) INTRINSIC FACTOR BLOCKING INSULIN, SPECIMEN 3 CALCIUM,IONIZED LEAD, BLOOD HSV 1 & 2, IGM DRVVT SCREEN W/REFLEXES THYROID STIM IMMUNO (TSI) LYSOZYME, SERUM T4 FREE, DIRECT DIALYSIS PARVOVIRUS AB IGG/M,B-19 CHROMOGRANIN A HOMOCYSTEINE CARDIOVASCUL TRYPTASE HERBICIDES PANEL 1 MENINGOENCEPHALOMYELITIS CORTICOSTERONE NTX 24HR URINE MERCURY IMM. COMPLEX BY C1Q BIND. MERCURY, URINE VITAMIN B2 M.HOMINIS/UREAPLASMA CULT METANEPHRINES,FRAC,24HR

CODE

1367 1376 1377 1378 1379 1380 1381 1383 1387 1391 1392 1393 1396 1411 1425 1428 1429 1430 1431 1432 1435 1437 1438 1439 1450 1451 1454 1456 1457 1461 1468 1472 1475 1476 1477 1480 1481 1483 1484 1485 1487 1493 1509 1513 1515 1517 1519 1524 1527 1529 1531 1534 1535 1536 1537 1538 1540 1541 1543 1545 1547

Quest Fee Schedule

PRICE

DESCRIPTION

$26.25 $45.50 $13.13

HGB A1C W/RFLX GLYCOMARK HSV TYPE 1 & 2 W/INTERP PYRAZINAMIDE, HPLC

$11.10 $62.30 $37.66 $27.58

$7.21

RUBELLA RNA,QL,RT,PCR TAMOXIFEN P450 GENOTYPE METHYLMALONIC ACID QNT QNS HPV HIGH RISK C DIF DNA/TOXIN B GENE QL

$247.00 $47.60

$114.63 $49.00 $77.00

VIT D,25-HYDROXY,1,25-D SLOS & STSD SCREEN BRAF MUTATION ANALYSIS YERSINIA ENTEROC IGG,IGA HLA-A29 DNA TYPING

$60.90 $44.10 $56.00 $26.25 $55.65

HLA-B51 DNA TYPING CF MUTATION SCREEN CALPROTECTIN, STOOL GENOMIC ALTERATIONS CGH HEMOGLOBIN A1C W/EAG

$44.10 $70.00 $49.00 $87.50 $136.50 $58.10 $96.25 $39.55 $34.30

INFLUENZA A H1N1,RT,PCR CELLSEARCH TUMOR, COLON CELLSEARCH, PROSTATE ANA SCREEN W/REFLEXES OXALATE, RANDOM URINE NRAS MUTATION ANALYSIS FETOMATERNAL BLEED, FLOW FISH, HES/LEUKEMIA 4q12 HISTAMINE RELEASE-CHRONIC

$59.50 $136.50

$57.75 $94.30 $91.35

ANTIMULLERIAN HORMONE CHROMOSOME,NEONATAL BLOOD ANTIMIC,ETHAMBUTOL, HPLC ALDOSTERONE/PRA-LC/MS/MS PLASMA RENIN ACTIVITY

$25.66 $25.66 $51.45 $67.90 $27.58

FISH,NHL,BCL6 3q27 REARNG PROF 2 W/CONF, UR PROF 2 W/O CONF, UR PROF 3 W/CONF, UR PROF 3 W/O CONF, UR

$31.50 $28.00 $25.66 $17.50 $22.75

PROF 1 W/CONF, UR PROF 1 W/O CONF, UR PDGFRA MUTATION ANALYSIS BAC ID PHENOTYPIC INFLUENZA A/B RT-PCR W/RF

$42.00 $15.75 $100.10 $31.85 $32.90

FISH,B-CELL LYMPH/LEUKEM SELENIUM, 24 HR URINE SELENIUM, RANDOM URINE HIV-1 INTERGRASE GENOTYPE FISH,IGH/FGFR3, t(4,14)

$49.00 $38.50 $56.00 $40.25 $211.00

BCR-ABL1 KINASE DOMAIN HIV-1,RNA,QUAL,CSF GENOMIC ALTERATIONS POC AMPHETAMINE, W/CONF, UR BARBITURATE, W/CONF, UR

$723.10 $35.35 $58.80 $38.50 $37.10 $38.50 $48.30 $51.80 $41.65

BENZODIAZEPINES W/CONF,UR COCAINE SCRN, W/CONF, UR MARIJUANA MET SCRN W/CON METHADONE SCRN W/CONF, UR OPIATES SCRN W/CONF, UR OXYCODONE SCRN W/CONF, UR PHENCYCLIDINE W/CONF, UR PROPOXYPHENE W/CONF, UR WILMS TUMOR(WT1)MUT ANLYS

CODE

16715 16720 16726 16730 16731 16732 16737 16739 16761 16764 16767 16768 16773 16775 16790 16796 16800 16802 16807 16811 16812 16814 16817 16818 16828 16837 16838 16842 16843 16844 16845 16846 16851 16852 16853 16854 16855 16856 16858 16859 16860 16861 16864 16866 16867 16868 16872 16876 16879 16884 16885 16886 16887 16888 16889 16890 16891 16892 16893 16894 16896

PRICE

$9.00 $57.75 $19.35 $104.30 $542.50 $49.70 $32.50 $104.30 $147.70 $166.25 $166.25 $59.50 $66.50 $66.50 $99.75 $61.25 $556.50

$9.00 $104.30 $203.00 $203.00

$19.25 $24.17 $138.25 $61.25 $181.30 $52.50 $54.60 $222.25 $64.05 $73.50 $31.50 $133.00 $159.39 $55.79 $192.59 $192.59 $259.00 $259.00 $199.50 $84.00 $104.30 $253.75 $48.30 $48.30 $154.00 $133.00 $162.75 $122.15 $556.50 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $297.50

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

TISSUE TRANSGLUTAM AB IGA SEX HORMONE BIND/GLOBULIN MICROALB 24HR W/CREAT IGA-FIBRONECTIN AGGREGATE MYELIN BASIC PROTEIN, CSF DEOXYCORTICOSTERONE PREGNENOLONE CANDIDA AB IgG,IgA,IgM MYOGLOBIN ANTI-LKM ANTIBODY 17-HYDROXYPREGNENOLONE NEUTROPHIL,OXIDATIVE HEPATITIS C ANTIBODY CHROMIUM, URINE INSULIN, SPECIMEN 4 NEUTROPHIL ANTIBODY,FC OSMOLALITY, STOOL Q FEVER ANTIBODY C3d IMMUNE COMPLEX COCCIDIOIDES CF & ID STRAITED MUSCLE AB W/RFLX THYROXINE BINDING GLOBUL IGF-1 BINDING PROTEIN ALLERGEN, RUSSIAN OLIVE THIOTHIXENE (NAVANE) THYROGLOBULIN TRANSFERRIN VARICELLA-ZOSTER IgG VASOACTIVE INT.POLYPEPTID VITAMIN A VITAMIN B1 (THIAMINE) VANILLYLMANDELIC ACID PKU HEEL STICK COLLECTION VITAMIN K, SERUM VMA, 24 HOUR URINE BORDETELLA PERTUSSIS DFA CADMIUM, URINE VERAPAMIL PHENYTOIN, FREE XYLOSE ABSORPTION, URINE XYLOSE ABSORPTION, BLOOD CADMIUM, BLOOD HEPATITIS C RNA,QL,PCR HEPATITIS C RNA PCR QUANT CULTURE, ACANTHAMOEBA GLUCAGON HEPATITIS C RNA, QT, BDNA V.ZOSTER IGM AB IGG SYNTHESIS, CSF HEAVY METALS PANEL,BLOOD AMINO ACID, LC/MS, URINE SELENIUM IGF BINDING PROTEIN-3 TICLOPIDINE (TICLID) 3a-ANDROSTANEDIOL GLUCUR. VITAMIN E PORPHOBILINOGEN, QUANT PROINSULIN HEPATITIS B CORE AB,IGM PORPHOBILINOGEN, QUANT ASPERGILLUS AB,CF

CODE

1549 1555 1556 1560 1562 1564 1566 1567 1568 1572 1573 1574 1590 1593 1612 1622 1624 1625 1628 1639 1649 1657 1658 1664 1669 1672 1678 1699 1705 1708 1711 1712 1714 1715 1720 1722 1728 1729 1731 1732 1733 1734 1737 1740 1742 1748 1749 1763 1775 1782 1783 1784 1786 1791 1801 1802 1806 1809 1810 1812 1816

Quest Fee Schedule

PRICE

DESCRIPTION

$42.35 $26.25 $16.59

ANAPLASMA IgG, IgM FENTANYL, QUANT, UR BUPRENORPHINE W/CONF, UR

$103.25 $34.30 $53.90 $37.80 $39.55

CARISOPRODOL , QUANT, UR TRICYCLIC AD, QUANT, UR GABAPENTIN, QUANT, UR MEPERIDINE, QUANT, UR TRAMADOL, QUANT, UR

$34.65 $21.00 $47.25 $60.90 $11.33

PREGABALIN, QUANT, UR MDMA/MDA SCRN W/CONF, UR HEROIN METAB, QUANT, UR BARBITURATE CONF, UR XYLOSE, FASTING

$32.55 $25.66 $54.95 $10.41 $32.55

BENZODIAZEPINES CONF, UR COCAINE METAB CONF, UR MARIJUANA METAB CONF, UR METHADONE CONF, UR OXYCODONE CONF, UR

$45.85 $47.95 $29.40 $32.20 $32.20 $39.88 $96.00 $49.53 $23.31

PHENCYCLIDINE CONF, UR PROPOXYPHENE CONF, UR CLOPIDOGREL CYP2C19-12345 MLH1 GENE SEQUENC,HNPCC MSH2 GENE SEQ HNPCC APC GENE DELETION OR DUP APC GENE SEQUENCING ASHKENAZI JEWISH PANEL MUM1 IHC W/INTERPRETATION

$29.82 $71.40 $31.15 $40.25 $50.05

HIV-1 QUANT W/REFLEX VEGF MUTATION ANALYSIS INFLUENZA H1N1 (2009) STREP PNEUMO IgG 23 MAID FISH,IGH/MAF,t(14,16)

$6.13 $74.90 $50.05 $26.25 $56.00

CAH PANEL 6C(FULL SCREEN) CMV DNA ULTRAQUANT COLOVANTAGE TRANSFERRIN CARBOHYDRATE DENGUE VIRUS IGG AVIDITY

$104.00 $17.50 $27.30 $27.30 $45.85

SULFAMETHAZOLE LEVEL HPLC OVA1 OVA1TM (LH AND FSH) CLONAZEPAM FORMALDEHYDE

$77.35 $147.70

$68.25 $37.10 $147.70

LUPUS ANTICOAGULANT EVAL PHENOLPHTHALEIN-FECES HIV PHENOSENSE GT CANDIDA AB IMMUNODIFF HLA TYPING CELIAC DISEASE

$26.60 $53.90 $107.10 $183.40 $38.85

CHLAMYDIA GROUP AB IFA FACTOR VIII INHIBITOR JC POLYOMA VIRUS DNA QUAL SALMONELLA IDENTIFICATION CLL PROGNOSTIC COMPREHENS

$28.70 $101.00

$60.55 $26.95 $17.15 $59.85 $34.35 $17.15 $35.35

CLL PROGNOSTIC LIMITED CLL PROGNOSTIC MONITORING KAPPA/LAMBDA LIGHT CHAINS CHLAMYDIA TRACHOMATIS DNA NEISSERIA GONORRHOEAE DNA CHLAMYDIA/N GONORRHOEAE VIT D,25-HYDROXY,LC/MS/MS ATT QUANT AND MUTATION CLL PROG COMPREH KAROTYPE

CODE

16897 16900 16901 16902 16903 16904 16905 16906 16908 16909 16911 16912 16913 16914 16916 16917 16918 16920 16921 16922 16924 16926 16928 16930 16934 16936 16957 16958 16959 16962 16963 16965 16978 16982 16983 16985 16987 16990 16991 16992 17052 17075 17079 17085 17100 17132 17135 17159 17168 17220 17226 17239 17240 17290 17300 17303 17304 17305 17306 17307 17312

PRICE

$23.45 $100.00

$60.00 $100.00 $100.00 $100.00 $100.00

$35.00 $100.00

$60.00 $60.00 $100.00 $27.30 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $138.25 $511.00 $511.00 $542.50 $630.00 $1,128.05 $57.75 $103.25 $82.25 $87.15 $193.90 $133.00 $369.60 $140.11

$0.00 $43.75 $51.80 $64.05 $227.50 $274.12 $24.68

$9.54 $31.50

$9.63 $1,787.00

$35.70 $71.75 $40.60 $77.00 $113.05

$0.00 $806.40 $469.00 $386.05

$42.18 $21.63 $21.63 $43.26 $68.25 $118.65 $534.80

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

CREATINE ANTI-DNA SINGLE STRANDED PTH-RELATED PROTEIN TETRAHYDROALDOSTERONE ANTI-THROMBIN III PYRUVATE MYASTHENIA GRAVIS PANEL CULTURE, CHLAMYDIA 17-OH-CORTICOSTEROIDS 24H 17-KETOSTEROIDS W/CR,24HR 17-OH-PROGESTERINE,LCMSMS 5-HIAA, 24 HR URINE ALLERGEN, BUMBLE BEE C1 INHIBITOR, FUNCTIONAL CAROTENE (BETA) ECHOVIRUS ANTIBODY PANEL HIV-1 DNA, PCR HLA-B27 PARAINFLUENZA AB 1-3 JO1 ANTIBODY LEAD, URINE OXALIC ACID, 24 HR URINE AMINOLEVULINIC ACID,DELTA VITAMIN B6 TOXOPLASMA AB IGG/IGM ESTROGEN, FRACTIONATED PM-1 ANTIBODY DHEA SULFATE ESTRADIOL LC/MS/LC CRYOGLOBULIN SCREEN W/RFL CULTURE AND SMEAR, AFB AFB SMEAR CULTURE, ANAEROBIC ANAEROBIC SENSITIVITY IDENTIFICATION ANAEROBIC ID ONLY, AEROBIC SENSITIVITY ONLY BACTERIAL TYPING BACTERICIDAL LEVEL GRAM STAIN STOOL FOR WBC INDIA INK PREP ID & SENSITIVITY, BLOOD FAT SCREEN, STOOL CLINDAMYCIN DISK INDUCTIO GROUP A STREP RAPID SCRN MUSCLE FIBERS FECAL GROUP A,STREP-NO REFLEX WET MOUNT HUMORAL IMMUNITY EVAL PNL BLOOD CULTURE, AFB CULTURE,FUNGAL BLOOD CULTURE,FUNGUS,OTHER FUNGAL SMEAR, OTHER FUNGAL ID, MOLD FUNGUS CULTURE W/O SMEAR FNG SMEAR,SKN,HAIR,NAIL FUNGAL ID, YEAST CULTURE,NOCARDIA CULT,FUNGUS,SKIN,HAIR,NAI CULTURE, BLOOD ARD

CODE

1832 1834 1837 1839 1848 1854 1862 1878 1900 1902 1903 1904 1918 1919 1922 1928 1933 1937 1940 1944 1946 1951 1953 1964 1965 1968 1975 1986 1987 1996 2000 2002 2010 2011 2019 2020 2021 2022 2023 2025 2026 2027 2028 2029 2030 2031 2033 2034 2035 2070 2120 2125 2150 2152 2154 2155 2156 2157 2158 2175 2200

Quest Fee Schedule

PRICE

DESCRIPTION

$26.25 $45.59 $64.40

LACTOFERRIN, QT, STOOL FISH, MANTLE CELL LYMPH FISH,FOLLICULAR LYMPHOMA

$78.75 $29.86 $22.40 $87.15 $33.95

FISH,B-CELL MALIGNANCY FISH, BURKITT'S/NHL/ALL FISH,LOCUS-SPECIFIC X1 RBC FRAGILITY - INCUBATED THALASSEMIA-HGB COMPLETE

$34.30 $68.60 $39.20 $26.25 $48.40

DONOR, HEP B SURFACE AG DONOR, HEP BC TOTAL DONOR, HTLV 1-2 AB DONOR, HIV 1-2 AB HEP C DONOR

$20.30 $26.60 $55.30 $101.50 $47.25

CHLAMYDIA GC DONOR PANEL DONOR, CMV TOTAL DONOR, RPR W/RFX SYPH IGG HLA-DQB1 HIGH RESOLUTION HLA-C HIGH RESOLUTION

$70.00 $19.25 $38.50 $24.15 $29.75 $61.25 $35.95 $116.90 $28.35

HLA-A2 TYPING W/REFLEX COLLAGEN TYPE I C-TELOPEP RHEUMATOID FACTOR, CSF PTT-LA W/REFLEX AFP, CSF AFP, PERITONEAL FLUID CA125, CSF CA 19-9, CSF CHLAMYDIA & CHLAMYDOPHILA

$52.50 $41.30 $12.25 $55.58

$9.45

CEA, CSF CEA, PERITONEAL FLUID CHOLINESTERASE RBC HIV-1 GENOTYPE PLUS HEAVY METALS, URINE

$15.37 $24.12

$7.25 $7.25 $4.80

PROTEIN S ACTIVITY W/RFLX HERPES SIMPLEX/VZV,RAPID IRON, 24 HR URINE HCG, TOTAL, CSF AFP, PERICARDIAL FLUID

$21.60 $45.15

$5.85 $4.97 $7.84

W NILE VIRUS RNA QUAL PCR BORRELIA BURGDORFERI DNA HERPES SIMPLEX, DNA (HSV) CEA, PLEURAL FLUID HCG TOTAL,PERITONEAL FLD

$12.39 $34.13

$4.80 $16.07 $29.72

COMPLEMENT C3,PLEURAL FLD COMPLEMENT C3,PERITONEAL COMPLEMENT C4,PLEURAL FLD COMPLEMENT C4,PERITONEAL COMPLEMENT C3, SYNOVIAL

$16.07 $4.10

$189.70 $22.37 $12.92

COMPLEMENT C4, SYNOVIAL LIPASE, PANCREATIC FLUID CEA, PERICARDIAL FLUID PENICILLIN PROFILE 2 FENTANYL & NORFENTANYL,UR

$28.18 $6.30

$25.38 $11.10

$6.30 $63.00 $11.41 $27.02 $23.77

ATYPICAL PNEUMONIA DNA CELIAC PANEL W/O GLIADIN C.TRACHOMATIS DNA,SDA N.GONORRHOEAE DNA,SDA CHLAMYDIA/N.GONORRHOEAE MALE INFERTILITY GENETIC SALMONELLA IGG,IGM,IGA CYTOCHROME P450 2D6/2C19 CA 19-9, PERITONEAL FLUID

CODE

17321 17346 17347 17348 17352 17355 17364 17365 17375 17378 17379 17380 17382 17385 17388 17389 17394 17395 17398 17406 17407 17408 17409 17410 17416 17417 17419 17420 17421 17430 17480 17492 17494 17495 17515 17548 17554 17563 17570 17581 17584 17587 17593 17594 17595 17596 17597 17598 17604 17605 17606 17607 17610 17612 17615 17617 17618 17625 17631 17634 17638

PRICE

$64.75 $147.70 $147.70 $138.60 $157.50 $126.00

$9.36 $59.50 $40.16 $43.75 $49.53 $54.08 $54.16 $73.50 $76.21 $33.69 $131.25 $131.25 $68.25 $48.65 $12.25 $15.75 $26.25 $29.40 $44.80 $34.30 $36.75 $29.40 $29.40 $19.95 $157.50 $314.65 $60.55 $68.95 $21.96 $28.00 $29.40 $113.75 $93.80 $99.75 $29.40 $28.00 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $10.41 $29.40 $28.00 $14.00 $254.80 $55.30 $24.50 $24.50 $42.00 $535.50 $32.55 $367.50 $34.30

Contract : 5753 Vendor : Quest Diagnostics

DESCRIPTION

BRUCELLA SCREEN FRANCISELLA TULARENSIS SC BACILLUS ANTHRACIS SCREEN CULTURE, FLUID CULTURE, GC CULTURE, WOUND CULTURE, SURGICAL CULTURE, AEROBIC HYDROCHLOROTHIAZIDE RISPERIDONE CULTURE,SPUTUM GRAM STAIN CULTURE, RESPIRATORY MRSA SCREEN CULTURE,URINE,ROUTINE CULTURE URINE SPECIAL CULTURE, STOOL W/RFLX SALMONELLA/SHIGELLA SCRN SCABIES EXAM CAMPYLOBACTER CULTURE SHIGA TOXINS W/RFLX CUL E COLI 0157 CULTURE CULTURE, VIBRIO CULTURE, YERSINIA STOOL CULTURE FOR VRE VRSA STREP GROUP A CULTURE STREP GROUP B CULTURE ALLERGEN, CAULIFLOWER IGE ALLERGEN CLOVE (F268) IGE CULTURE, VARICELLA ZOSTER ALLERGEN, PAPAYA IGE CULTURE, VAGINAL CULTURE, VAGINAL OVA AND PARASITES GIARDIA LAMBLIA SCREEN CRYPTOSPORIDIUM AG STOOL ALLERGEN GREEN PEPPER IGE OCCULT BLOOD DIAG (1SPEC) OCCULT BLOOD SCRN (1SPEC) PINWORM EXAM OCCULT BLOOD DIAG (2SPEC) OCCULT BLOOD DIAG (3SPEC) OCCULT BLOOD SCRN (2SPEC) OCCULT BLOOD SCRN (3SPEC) ANACHOICE W/RFL TITER,IFA ANA WITH PATTERN ANACHOICE W/REFLEX DS-DNA ANTI-DNA AB-DOUBLE STRAND ANTI-NUCLEAR ANTIBODY ANTI-SM (SMITH) SJOGREN'S ANTIBODIES (ID) SJOGRENS AB (SS-A) SJOGRENS (SS-B) SLCERODERMA ABS (SCL-70) SLE DIAG PANEL,DRUG INDUC MIXED CONNECT TISS DISEAS LUPUS/RHEUMATOID ARTHRIT EPSTEIN BARR VIRUS PBC DIAGNOSTIC PANEL,COMP EUGLOBULIN CLOT LYSIS TME THYROGLOBILIN ANTIBODIES

CODE

2215 2220 2230 2250 2252 2275 2277 2300 2330 2339 2350 2375 2381 2400 2404 2500 2501 2502 2504 2506 2507 2510 2520 2550 2551 2600 2601 2635 2638 2691 2720 2800 2801 2900 2905 2930 2931 2940 2945 2950 2960 2961 2962 2963 3000 3004 3009 3010 3013 3016 3020 3021 3022 3025 3027 3028 3029 3031 3032 3043 3055

Quest Fee Schedule

PRICE

DESCRIPTION

$11.10 $11.10 $11.10

HCG TOTAL, PLEURAL FLUID GLUCOSE, PERICARDIAL FLD CA 19-9, PLEURAL FLUID

$16.07 $7.21

$16.07 $16.07 $10.22

CA 19-9, PERICARDIAL FLD HCG TOTAL,PERICARDIAL FLD ALBUMIN, SYNOVIAL FLUID LDH, PERICARDIAL FLUID 17 HYDROXYPROGESTERONE

$108.00 $32.20 $16.07 $11.43 $4.66

LDH, SYNOVIAL FLUID RHEUMATOID DIAGNOSTIC PNL H. PYLORI ANTIBODY, IGG H PYLORI IGA ANTIBODY LYMPHO MITOGEN/AG STIMUL

$11.43 $10.57 $30.54 $10.89

$6.30

MANTLE CELL LYMPHOMA C3A DESARG FRAGMENT FOLLICULAR LYMPHOMA H PYLORI AB, IGA & IGG ADENOSINE DEAMINASE PLURL

$10.89 $23.85 $18.11 $29.65 $29.65 $29.61 $29.61

$4.66 $4.66

ADENOSINE DEAMINASE PERTL ADENOSINE DEAMINASE CSF CLL IGVH MUTATION STATUS ANGIODEMA PANEL CA 125 W/HAMA TREATMENT COMPLEMENT C3,PERICARDIAL COMPLEMENT C4,PERICARDIAL LUPUS ACTIVITY PANEL 2 DONOR, HIV-1/HCV NAT

$7.00 $36.90 $45.50

$7.00 $14.32

AVIAN INFLUENZA H5 GENE AVIAN INFLUENZA H5 GENE BASIC METABOLIC W/O CAL COMP METABOLIC W/EGFR COMP METABOLIC W/O ALT

$10.54 $18.03 $20.55 $29.40

$7.00

CREATININE CLEARANCE/EGFR HTLV I/II, WESTERN BLOT UGT1A1 GENE POLYMORPHISMS CLL LYMPHOMA DIAGNOSTIC CLL LYMPHOMA FOLLOW UP

$4.52 $4.52 $4.52 $8.61 $12.92

HCL LYMPHOMA FOLLOW UP PLASMA CELL NEOPLASIA ACUTE LEUKEMIA FOLLOW UP SLIDE RETURN REQUEST ALDOSTERONE - ACTH

$12.92 $12.92

$7.21 $16.49 $19.25

FIRST TRIMESTER SCREEN FACTOR V ACTIVITY FACTOR IX ACT & INHIBITOR E.CHAFFEENSIS IgG,IgM BCR/ABL REARRANGEMENT

$19.25 $12.95 $19.25 $38.50 $19.25

FACTOR XI ACT & INHIBITOR T-CELL RECEPTOR QUANT T-CELL RECEPTOR QUAL GROUP B STREP, PCR FACTOR V PCR (LEIDEN)

$19.25 $19.25 $49.35 $38.50 $63.00 $111.65 $150.15 $25.20 $16.80

FACTOR V HR2 ALLELE MUT FACTOR V MUTATION THROMBOPHILIA DNA MUTAT FACTOR II MUTATION DNA MTHFR DNA MUTATION PROTEIN C & S ACTIVITY B. BURGDORFERI AB INDEX C TRACHOMATIS ABS IGG/A/M CATECHOLAMINES/VMA 24 HR

CODE

17639 17641 17642 17643 17644 17646 17647 17654 17658 17669 17670 17671 17678 17679 17689 17690 17691 17696 17697 17698 17702 17706 17717 17718 17719 17725 17746 17750 17751 17759 17760 17761 17763 17780 17813 17817 17818 17819 17820 17821 17828 17832 17833 17844 17845 17851 17853 17854 17861 17862 17869 17900 17902 17904 17907 17909 17911 17942 17970 18036 18061

PRICE

$28.00 $8.75

$34.30 $34.30 $28.00

$7.70 $7.35 $39.20 $7.35 $43.75 $38.50 $38.50 $454.65 $134.75 $43.05 $147.00 $77.00 $52.50 $52.50 $52.50 $148.75 $77.35 $34.30 $34.30 $34.30 $65.80 $160.91 $113.75 $113.75 $6.03 $5.74 $5.85 $12.81 $35.00 $122.50 $0.00 $0.00 $0.00 $0.00 $0.00 $5.25 $73.50 $47.25 $100.80 $127.40 $51.10 $151.20 $127.40 $140.00 $102.90 $33.25 $91.00 $80.50 $92.75 $200.90 $68.25 $108.50 $225.40 $199.85 $36.75 $89.25

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